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[Task and task time should dictate the choice of gloves in health care services].

Worldwide consumption of medical gloves increased during the 1980's due to the recognized risk of cross infections in medical and dental care. In Stockholm County Council around 1 million pairs of surgical gloves and 18 millions pairs of examination gloves are purchased per year. In the following paper different glove materials and types are presented and also regulations on use and purchase. The protective capacity of gloves and contact hypersensitivity reactions are also discussed and advice is provided on glove usage.

Dermatitis, Allergic Contact↗

Ease of donning commercially available powder-free surgical gloves.

There are a wide variety of powder-free gloves that can now be used by surgeons. The purpose of this study was to quantify the forces required to don these powder-free surgical gloves. The lowest donning forces for wet hands was encountered with powder-free gloves coated with a hydrogel polymer. In addition, the hydrogel coated gloves exhibited the least increase in donning forces from dry hands to wet hands. While greater forces were encountered with the other commercially available powder-free gloves than the hydrogel coated gloves, they all could be safely donned on dry hands without tearing.

Analysis of Variance↗

Integrity of powder-free examination gloves to bacteriophage penetration.

The purpose of this study was to compare the resistance to viral penetration of powder-free synthetic examination gloves with powder-free latex examination gloves commonly used in hospitals. Because these gloves had no holes, this study examined viral penetration through a membrane. Using a standard bacteriophage penetration model, no bacteriophage penetration was detected through the membrane for any of the gloves tested. The new powder-free nitrile and polyvinyl chloride synthetic examination gloves provided comparable resistance to viral penetration as did the powder-free latex examination gloves.

Bacteria↗

Convenient training method for aortic cannulation: glove- and-peel method.

Aortic cannulation is a difficult technique for young cardiovascular surgeons. A convenient training method for this procedure is introduced in this paper. After two gloves are worn on a hand, they are removed together, then a piece of mandarin-orange peel is inserted between the gloves. The inner glove is filled with water and the mouth of the inflated gloves is securely tied with a strong ligature. Then this "glove balloon" is set inside a container to stabilize it. Purse-string stitches are placed on the orange peel. After the center of the purse string is incised with a number 11 blade, a cannula is introduced. This "glove-and-peel method" will help young cardiovascular surgeons to become accustomed to aortic cannulation.

Aorta↗

Association of contaminated gloves with transmission of Acinetobacter calcoaceticus var. anitratus in an intensive care unit.

PURPOSE: Acinetobacter calcoaceticus var. anitratus is an important nosocomial pathogen that has been associated with environmental reservoirs. An increased isolation rate of A. anitratus in our intensive care units (ICUs), from 0.03% (two of 7,800) to 0.5% (seven of 1,300) (p less than 0.00003), prompted an investigation. PATIENTS, METHODS, AND RESULTS: Ten patients were admitted to the surgical ICU and nine to the medical ICU during the outbreak period (late December 1987 to January 1988). Controls were all patients on the units who were not infected or colonized with the transmitted strain of A. anitratus. Three patients had A. anitratus pneumonia. A throat culture prevalence survey demonstrated three patients colonized with A. anitratus. Cases were placed in a cohort and symptomatic cases treated. An epidemiologic investigation was conducted to identify reservoirs and modes of transmission. Latex gloves were being used for universal precautions without routine changing of gloves between patients. Environmental sources culture-positive for A. antitratus included a small volume medication nebulizer and gloves in use for patient care. Plasmid typing showed that plasmid profiles of isolates from two symptomatic patients, two colonized patients, the nebulizer, and the gloves were identical. Other A. anitratus ICU isolates had distinct plasmid profiles. All patients with the transmitted strain had been in the surgical ICU. The need for changing gloves between patients and contaminated body sites was reinforced. CONCLUSION: Gloves, used incorrectly for universal precautions, may potentially transmit A. anitratus.

Acinetobacter Infections↗

Blood exposure in single versus double gloving during pelvic surgery.

In light of continued reports suggesting the inadequacy of surgical gloves as sterile barriers, as well as an increasing number of reports describing intraoperative cross infections, a prospective study was performed comparing the presence of visible blood on the hands of surgeons wearing single or double gloves during 45 consecutive major obstetric and gynecologic operations. Single-gloved hands revealed the presence of visible blood in 38% of cases (n = 42) whereas visible blood was noted in only 2% of double-gloved hands (n = 48) (p less than 0.001). These results demonstrate that the sterile barrier between surgeon and patient was compromised intraoperatively and that particles the size of red blood cells were able to cross this barrier. In addition, these data suggest single gloving may be less than optimal in maintaining a sterile barrier, as well as strongly suggesting that double gloving can improve the integrity of the patient-surgeon sterile barrier during pelvic surgery.

Blood↗

The mechanisms and risks of surgical glove perforation.

Intact surgical gloves are a barrier to hepatitis B virus and human immunodeficiency virus (HIV) but once perforated during surgery they cannot sustain adequate defence. This study examines the rate of glove perforations during surgery at a District General Hospital. In total, 275 pairs of gloves were collected from 100 consecutive operations. In the 43% of gloves that had been damaged 200 perforations were recorded. The mean rate per operation in the surgeon's gloves was 1.18. Injuries to the non-dominant index finger were significantly higher than injuries to other parts of the hand. Injuries occurred particularly during manipulation of the needles and at wound closure. Consultants were more likely to have glove perforation than juniors. Operations requiring manipulation of instruments deep within the wound had a higher rate than those on the surface. The results of the study indicate that a surgeon risks more than one hepatitis B infection per lifetime and that at least one in 1500 surgeons is likely to be infected by HIV during the next 35 years.

Equipment Failure↗

Preliminary experience with polyethylene fibre glove liners in oral and maxillofacial surgery.

The poor performance of latex gloves in preventing penetrating injury is well established. Oral and maxillofacial surgeons face the additional problems associated with wiring techniques and high-speed rotary instruments. A pilot study is presented assessing the efficacy of high-strength polyethylene fibre gloves, used in a triple-gloving technique, in preventing inner glove perforation. The results showed that there were fewer perforations of the inner glove in the surgeon wearing the glove liner, but the difference was not significant.

Bone Plates↗

Protection by latex or vinyl gloves against cytotoxicity of direct bonding adhesives.

The cytotoxicity of orthodontic bonding agents (OBAs) has been demonstrated in both animal and in vitro studies. Many practitioners and their assistants have experienced contact dermatitis of the fingers following contact with OBA. Latex gloves have also been reported to cause similar symptoms in several reports. The purpose of this study was to evaluate and quantify the toxic effects of latex and vinyl gloves, several OBAs, and combinations of these in vitro to determine the kind of glove that should by worn by practitioners when manipulating an OBA. It was determined that when OBAs are applied to washed latex, the combined toxic effect on cultured cells exceeded that of the washed gloves alone. However, when vinyl glove material instead of latex was tested, the toxic effects decreased more than 50%. Therefore, we suggest that practitioners who experience contact dermatitis in orthodontic practices wear vinyl gloves instead of latex, especially when manipulating OBAs. We also acknowledge the need for further research on the subject.

Adhesives↗

Permeation of a straight oil metalworking fluid through a disposable and a chemically protective nitrile glove.

The aim of the present study was to quantify the permeation parameters of a complex water-insoluble straight oil metalworking fluid (MWF) of low volatility through nitrile gloves. The permeation through a chemically protective and a disposable glove was investigated using the American Society for Testing and Materials (ASTM) F739-99a method with hexane as the collection medium. Analysis of collection side samples involved gas chromatography-mass spectrometry (GC-MS) and gravimetry. The detection breakthrough time for the chemically protective glove was >10 h. For the disposable glove, the detection breakthrough time was 0.7+/-0.3 h, the lag time was 1.6+/-0.1 h, the diffusion coefficient was (3.7+/-0.3)x10(-9) cm2/min, and the steady state permeation rate was 3.5+/-2.2 microg/cm2/min. The disposable nitrile glove can be worn for about 30 min for incidental contact with straight oil MWFs without known carcinogens. The chemically protective nitrile glove should be worn otherwise. The chromatogram for the permeate differed from that of the original MWF, resulting from the faster permeation of lower molecular weight congeners. The combination of chromatography and gravimetry allowed quantifying the permeation parameters of complex water-insoluble non-volatile mixtures.

Gas Chromatography-Mass Spectrometry↗

Implementing a nonlatex surgical glove study in the OR.

Sterile surgical gloves are used to protect patients and health care workers (HCWs) from infection during surgery and to shield HCWs from exposure to bloodborne pathogens. Based on increased reports of latex allergy, many HCWs now use nonlatex surgical gloves as a substitute for natural rubber gloves. Little is known, however, about the performance of nonlatex gloves in surgery. This article describes a study that currently is being performed to test the barrier performance of nonlatex surgical gloves after they have been used in surgery and to determine HCW satisfaction. To date, 12,703 latex and nonlatex gloves from all surgical services have been collected and tested for barrier quality. This article describes the project and challenges encountered by the collaborative team of perioperative staff members and nurse researchers as they collect data.

Consumer Behavior↗

Surgical glove failures in clinical practice settings.

Health care personnel often pay little attention to the barrier effectiveness of the surgical gloves they use in clinical settings. They may assume that all surgical gloves provide adequate protection against the transfer of bloodborne pathogens, chemicals, or mutagenic substances. Perioperative staff members frequently are unaware that their surgical gloves have failed until they find blood on their hands after operative procedures are completed. In this first article of a three-part series, the authors review current surgical glove testing standards, define surgical glove failure, and describe the reasons that surgical glove failure occurs in clinical practice settings.

Equipment Failure↗

[Surgical glove use in France].

Since the end of the 19th century, surgeons have used gloves to prevent infectious complications to the patient. The AIDS epidemic of the 1980's sparked the use of universal precautions to protect the surgeon from infection and vice-versa. The interface between surgeon and patient is in effect a two-way street. Surgical techniques must be modified and barrier protection optimized to minimize these risks. A single layer glove is a fragile barrier to blood exposure; unrecognized glove perforations may lead to unrecognized and prolonged exposure. Double gloving, though far from being a widespread practice in France, seems to be the best protection from pathogen exposure. Glove powder and latex allergies have their own inherent risks to both surgeon and patient in the form of latex allergies and adhesive peritonitis. New institutional protocols will be necesssary in order to make powder-free non-latex gloves available to French surgeons.

France↗

Effect of choice of surgical gloves on dough time measurements of acrylic bone cement.

In this study we investigated the effect of the brand of surgical gloves on the dough time determination for acrylic bone cements. Four different brands of powder-free latex surgical gloves were tested. Two commercial bone cements, Surgical Simplex P and Palacos R, were used for dough time measurement following standard test methods for acrylic bone cements (ASTM F-451 and ISO 5833). The results show that the measured dough time depended largely on the brand of gloves used, and could vary by nearly 250%. The surface morphological structures of gloves, determined by SEM, probably contribute to the differences in the measured dough time. This study provides experimental evidence that supports the need to describe the type of gloves used, in detail, when dough time is reported. It also illustrates the importance of the glove brand, when bone cement is to be handled as a dough in the clinical setting.

Biocompatible Materials↗

A comparison of bacterial adherence to bare hands and gloves following simulated contamination from a beef carcass.

One of the risks for contamination of edible product in the pre-inspection area of processing lines in meat plants is cross contamination. This can occur directly as a result of carcass-to-carcass contact or indirectly via knives or the hands of butchers. Standard procedures require that operators rinse their hands and knives to remove any visible contamination. In New Zealand, protective gloves are not allowed in the pre-inspection area because they are considered a potential risk for cross contamination until the carcasses have passed the final meat inspection. However, the risk of injury to the bare hands is as high in this area as in other parts of the plant, where such gloves are permitted. There is therefore a need to evaluate the risk of bacterial cross contamination via bare hands and via protective gloves. The present study compared bacterial adherence to bare hands and to gloves after rinsing for 5 s in a shower of water at 40 degrees C and after rinsing gloves in hotter water (60 degrees C) following simulated contact with the hide of a recently slaughtered animal. Under laboratory conditions there were no statistically significant differences between bacterial adherence to bare hands or to gloves rinsed in water at 40 degrees C or 60 degrees C.

Animals↗

Surgical glove lubricants: from toxicity to opportunity.

In most emergency departments, surgical gloves are coated with surface powders that act as lubricants to facilitate donning. Cornstarch powder is an absorbable powder employed as a donning agent on most powdered gloves. Talcum powder, a nonabsorbable powder, is used as a mold release agent in glove manufacture and is still commonly found on the surfaces of modern surgical gloves. These powders are foreign bodies that elicit inflammatory responses, leading to a wide number of symptoms and complications. The best method of preventing clinical complications from glove powder is to use powder-free gloves.

Gloves, Surgical↗

The combined use of moisturizers and occlusive gloves: an experimental study.

BACKGROUND: Protective gloves are used in the workplace to protect the hands from occupational hazards, but side effects from glove use are frequently reported. Among these side effects, irritant skin reactions are common. OBJECTIVE: The present study was undertaken to investigate whether applying a moisturizer to compromised skin before wearing an occlusive glove could reduce skin irritation. METHODS: Healthy volunteers had both hands immersed in a sodium lauryl sulfate solution twice daily for 2 days. After each immersion, one hand had a moisturizer applied and both hands were put in occlusive gloves for 2 hours. Skin barrier function was evaluated by transepidermal water loss, skin hydration was measured by electrical capacitance and inflammation was evaluated by colorimetry. RESULTS: The moisturizer had a statistically significant positive effect on both the water barrier function and the hydration level of the skin. Although not statistically significant, less inflammation was observed on the moisturizer-treated hand. CONCLUSION: The findings suggest that use of a moisturizer under an occlusive glove may diminish irritation from exposure to a detergent followed by glove wearing.

Adult↗

Allergologically relevant rubber accelerators in single-use medical gloves.

To prevent contact with specific rubber accelerators, sensitized patients have to know in which glove brands these accelerators are present. Additionally, quantitative measurements of the bioavailable amounts of accelerators are needed to assist consumers in selecting gloves with the lowest possible amount of residual rubber accelerators. The aim of the study was to develop an analytical method by which residuals of rubber accelerators in single-use medical gloves could be determined qualitatively and quantitatively. 19 different glove brands were analysed for content of accelerators, and the results were compared to manufacturers' ingredient claims of the identical gloves. ZDEC, ZDBC, ZMBT and ZPC were the most frequently detected chemicals. In 9 of 15 gloves discrepancies were found, usually minor, between content of accelerators declared by manufacturers to be present and accelerators detected by analysis. Both phosphate buffer and acetone were tested as extraction media. No accelerators were detectable with the described chemical analysis in phosphate extracts, whereas acetone was demonstrated to be a technically suitable medium for extraction. However, more kinetic studies of the extraction procedure and studies of skin penetration are needed to document that the extraction procedure simulates the clinical situation.

Allergens↗